Twenty-one digital health startups took their final bows in front of a standing-room-only audience—and more than 2,000 people watching via livestream—as part of the Texas Medical Center Innovation Institute’s TMCx Demo Day on June 8.

Their pitches, in front of hospital stakeholders, advisors and members of the Houston innovation ecosystem, followed a four-month intensive program that included more than 100 hours of entrepreneurship curriculum, as well as introductions and meetings with advisors and key hospital decisionmakers.

The TMCx accelerator program couples the resources of the world’s largest medical center with the innovative spark of entrepreneurs to provide a comprehensive and practical curriculum for participating company founders.

In fall 2016, more than 300 companies competed for acceptance into TMCx, and almost 20 percent of those startups hailed from Silicon Valley, Calif. The fourth class of companies also included three Australian companies from the Texas Medical Center’s new BioBridge health technology startup exchange program, designed to create a global health ecosystem linking the United States and Australia.

“We were focused on digital health, and we saw everything that fits under that umbrella this time,” said Erik Halvorsen, Ph.D., director of the TMC Innovation Institute.

He also praised the companies, saying this was “statistically is the most successful class we have run.” He pointed to the 82 executed pilots and agreements made by the companies.

“It is impressive and truly a testament to the hustle by these companies and to the institutions for them to embrace innovation and figure out how to work with these companies,” he said. “It is a message to future companies coming here that you can raise money in Houston and get engagement by these hospitals.”

To continue to provide a welcoming atmosphere for startups and clinical work, the Texas Medical Center is collaborating with its member institutions to offer one Institutional Review Board document for clinical trials, set to launch later this year.

“Imagine, we have 29 IRBs in this medical center, so you would have to go to 29 individual groups to put together a clinical trial,” said William F. McKeon, president and CEO of the Texas Medical Center. “We are about to launch the TMC IRB—one signed document to access to the entire medical center. Essentially, we will have one universal front door to the Texas Medical Center.”

In addition to the agreements made, the companies also participated in 522 customer engagements with advisors, clinicians, investors and key opinion leaders to refine their value proposition and determine their product and market fit.